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Stress Fracture

Case Detail

Anatomy: Musculoskeletal
Borders
Heather Borders, MD
Diagnostic Category: Trauma
Created: over 5 years ago
Updated: over 5 years ago
Tags: PEDS
Modality/Study Types: MRI
Activities:
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History

14 year old elite runner with persistent left hip pain. Patient had negative radiographs three days prior to MRI.


Case Images


Diagnosis

Stress Fracture of the left femoral neck

Findings

Hypointense T1 and STIR fracture line in the medial left femoral neck with surrounding hypointense T1 and hyperintense STIR edema. There was also medial periostitis (not well seen on these images).

Discussion

Femoral neck stress fractures in skeletally immature patients are rare with only a handful of cases reported in the literature. The reported cases have been located medially, as in this case. Diagnosis is important to prevent progression to a complete fracture.

Plain radiographic findings may be very subtle and many times the study is normal. Radiographs may show periosteal new bone, trabecular disruption or a sclerotic fracture line.

MRI findings include edema on T1 and STIR, periostitis and hypointense fracture line. There is a spectrum of stress related injury varying from a normal MRI to periosteal edema to high signal on STIR and normal T1 signal to marrow edema on both T1 and STIR to marrow edema and a fracture line (this case).

Reference

The Journal of Bone and Joint Surgery (American) 86:1292-1295 (2004)

Musculoskeletal MRI. Second Edition. Helms et al. pp 161-164.



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